Careful: Crosswalks can be your best friend — or worst nightmare.
ICD-10 codes are coming soon, and they’re a lot more detailed than ICD-9. Use the following examples to get a feel for the higher granularity you’re looking at for common rehab diagnoses.
1. Flaccid Hemiplegia
An OT documents a visit for a right-handed client with flaccid hemiplegia impacting the right side. “In ICD-9, the therapist could code the treatment diagnosis of 342.01 (Flaccid hemiplegia and hemiparesis affecting the dominant side),” says Jeremy Furniss, MS OTR/L, coding and payment specialist for the American Occupational Therapy Association (AOTA). “The ICD-10, however, looks at dominant and non-dominant as well as laterality, so the ICD-10 code is G81.01 (Flaccid hemiplegia affecting right dominant side).
Question: We have been facing challenges for reporting bilateral procedures like injection codes 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level) and 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed). Is it better to report modifiers LT and RT to each injection or append modifier 50 to one injection code?
If you were busily trying to prepare your meaningful use attestation for the 2014 reporting period, CMS has offered you a bit of breathing room. The deadline for attestation is now March 20, giving you three more weeks of prep time than you had before to attest to meaningful use. In addition, CMS is extending the EHR reporting option for PQRS to March 20 as well.
As long as you comply with the electronic health record (EHR) reporting option rules by 11:59 pm EST on March 20, you’ll be in the clear for meaningful use compliance.
Don’t fall for DSAP diagnosis trap.
Your surgeon treats a patient with a fairly large, circular keratotic lesion on a patient’s right ankle. That sounds like a simple enough case, but read on to see what trials await you as you zero in on the proper diagnosis and procedure codes.
Focus on Diagnosis
The patient presents with a 0.9 cm lesion on the right ankle that appears hyperkeratotic. Suspecting a wart (078.1, Viral warts) or actinic keratosis (702.0, Actinic keratosis), the surgeon treats the lesion.
The patient returns three months later because the lesion has returned. It is now 1.3 cm in diameter and consists of a “plaque” surrounded by a ridge-like border. The surgeon removes the lesion and sends the specimen to pathology. The pathology report reveals a classic cornoid lamella, which is a thin vertical column of parakeratosis in the epidermal stratum corneum that makes up the outer “ring” of the lesion.
If you’re feeling hesitant to adapt to ICD-10, it’s time to start planning.
With just six months left until use of ICD-10 codes is mandatory, there are still some practices that are feeling more defiant than compliant. If you remain opposed to the ICD-10 transition, CMS offers a stark reality in its recent website FAQs, letting you know that you simply won’t be able to collect from the program if you turn your back on the new coding system.
If you don’t switch to ICD-10, your claim “cannot be processed,” the agency bluntly explains. Of course, this means that any services you submit to Medicare, Medicaid or any other payer covered by the HIPAA laws will have to transition to ICD-10 or else they won’t get reimbursed for their charges.
Question: I’ve heard that the mass of a uterus is important for choosing the proper code, so how do I use that information in my code selection for the pathologist’s uterus exam?
You could be tying half of your pay to quality within three years.
Although Medicare’s fee-for-service payment model has most likely been the norm as long as your practice has been accepting Part B payments that could change in the not-too-distant future.
On Jan. 26, HHS Secretary Sylvia M. Burwell announced a new plan that will allow CMS to reimburse providers based on quality of care, rather than the number of procedures and services they provide.
“HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018,” CMS reps said in a statement.
Ask for pre-authorization from the carrier to repeat a capsule study due to previous technical problems.
Reporting capsule endoscopy is not just about knowing the procedure codes and when to use them. It is also about being proficient enough to report interrupted procedures, delayed procedures, or other such contingencies. Remain on top of these situations armed with the knowledge of the correct modifiers.
If you are reporting only the professional component for your capsule endoscopy services ((i.e., interpretation and report of the results), you should append professional component modifier 26 (Professional component) to the appropriate code. For example, if your physician is part of a facility, and the facility owns the equipment used for the endoscopy, the gastroenterologist will only report the professional component.
The February 2015 CPT® Assistant highlights the changes made in the Medicare physician payment schedule in 2015. You will see how the final conversion factor takes into account the adjustment the Protecting Access to Medicare Act of 2014 (PAMA) brought about for the sustainable growth rate (SGR). Also, check out the Relative Value Scale Update Committee (RUC) recommendations of fee schedule changes for 2015.
You can also sharpen your skills for appropriately reporting arthrocentesis codes with the latest CPT® Assistant. Plus, nail down correct codes for reporting paravertebral facet joint nerve destruction. You can use SuperCoder.com’sCode Connect search to update your skills on all of these topics:
- Arthrocentesis: 20600-20611, 27370, 76942, 77002, 77012, 77021
- Medicare Physician Payment Changes in 2015: 92961, 92986-92990, 92997-92998, 99490
- Paravertebral Facet Joint Nerve Destruction: 64633-64636, 64999.
The customary FAQ section is also available in the latest CPT® Assistant to help you resolve your toughest coding cases. For the assistance you need, search for these codes and keywords on Code Connect:
Here’s your chance to see how prepared you are for the new system.
With the ICD-10 implementation date only months away, CMS is taking a four-pronged approach to ensuring that CMS and Medicare Fee-for-Service (FFS) practices are prepared. Read on to know what to expect, based on what Stacey Shagena with Medicare Contractor Management Group/CMS shared about Medicare’s testing plan during an MLN Connects call “Transitioning to ICD-10” on Nov. 5, 2014.
The four areas of focus for CMS are: